RARE - Writing Scholarships

Type your answers in the form, print 3 copies, and sign.

Submit a total of 3 copies of your essay, each having this completed form stapled to the top. Essays must be one full-page.

Send it to: RARE Everyday Hero Scholarship, 27500, Cosgrove, Warren, MI, 48092

Student Information

First Name
Middle Initial
Last Name
Gender:		Male Female
Home Address
City
State, Zip		-
Preferred Phone		- -
Email Address
Parent or Legal Guardian
Michigan College/University or Post Secondary School Planning on Attending:

High School Information

School Name
School Address
School City / Zip		-
Teacher / Advisor Name
Teacher / Advisor Email
Teacher / Advisor Phone		- -

Everyday Hero Information

Hero Name
May this person be contacted?		Yes No
Hero's Phone Number		- -
Hero's Email Address
Hero's Place of Work
Hero's Job/Occupation
Street Address of Workplace
City of Workplace
State / Zip of Workplace		-

Please Star the industry that best describes where your hero works

Arts/Communication/Entertainment
Automotive/Manufacturing
Building/Construction

Education
Food/Hospitality
Health Care/Science

Non-profit/Public Service
Technology
Other_________________

I am confirming that the information provided is correct and accurate to the best of my knowledge and that my essay is an original document and has not in any way been duplicated from another source.

_______________________________________________________________
Applicant Signature

_________________
Date

_______________________________________________________________
Teacher/Advisor Signature

_________________
Date